Lived Experiences of Nurse Managers in Resource-Constrained Settings: A Systematic Review and Thematic Meta-Synthesis of Leadership, Quality of Care, and Staff Development

Nurse managers are pivotal to sustaining safe and effective care in resource-constrained environments. Their roles extend beyond administrative oversight to encompass advocacy, improvisation, and direct problem solving, often under conditions of chronic scarcity【1–3】. Evidence on their lived experiences, however, remains fragmented across regions and designs【4】.

Methods

We conducted a systematic review and thematic meta-synthesis following PRISMA 2020【5】. Six databases (PubMed, CINAHL, Embase, Scopus, Web of Science, and AJOL) were searched for studies between 2000 and 2025. Eligible studies included qualitative or mixed-methods research focusing on nurse managers or unit leaders in low-resource or rural settings.

Thirty studies met inclusion criteria. Data extraction captured leadership approaches, concerns, quality of care issues, and staff development strategies. Thematic synthesis identified cross-cutting patterns.

Results Five meta-themes were identified. (1) Leadership under scarcity: managers relied on participatory, relational, or improvisational strategies to maintain services【6,7】. (2) Concerns and barriers: staff shortages, documentation gaps, referral delays, and equipment scarcity dominated accounts【8,9】.

(3) Quality of care trade-offs: managers described balancing scarce devices, prioritizing high-acuity patients, and rotating staff to sustain minimal standards【10】. (4) Staff development: formal continuing professional development (CPD) was rare; instead, managers relied on peer-led mentoring, WhatsApp CPD groups, and NGO-supported training【11–13】. (5) Resilience and well-being: moral distress and burnout were widespread, yet community values and informal peer support sustained commitment【14,15】.

Conclusions Nurse managers in resource-constrained settings act as system stabilizers, absorbing organizational deficits through improvisation and advocacy. Policy must prioritize structured leadership development, equitable resource allocation, and sustainable CPD models to strengthen quality of care and workforce resilience【16,17】. Keywords Nurse managers; leadership; resource-constrained settings; quality of care; staff development; systematic review; meta-synthesis